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Bipolar Disorder and Addiction: Everything You Need to Know

By Taylor Weeks
Medically Reviewed by Yilang Tang, MD, PhD on July 11, 2021
Bipolar disorder and substance abuse are separate conditions, but there is a strong association between them.

Bipolar disorder is a mental health condition that presents with severe mood swings. These mood swings alternate between periods of extreme emotional highs (called mania) and periods of depression. Like many types of mental illness, bipolar disorder is a risk factor for addiction, including substance use disorders. 

Is There a Link Between Bipolar Disorder and Addiction?

Bipolar disorder and addiction have a high level of comorbidity — meaning that people often experience both at the same time. According to the Substance Abuse and Mental Health Services Administration (SAMSHA), research suggests that as many as 30-50% of people with bipolar disorder may develop comorbid substance abuse disorder at some point in their life. Similarly, Mayo Clinic lists drug and alcohol abuse as a risk factor for developing bipolar disorder.

While we know that people with bipolar disorder are more likely than the general population to develop substance use disorder, it's hard to say why exactly this is the case.

However, in their 2020 research report on common comorbidities with substance use disorder, the National Institute on Drug Abuse (NIDA) explains that there are three main pathways that contribute to the association between substance use disorder and mental illnesses, including bipolar disorder.

1. Shared risk factors may contribute to both bipolar disorder and addiction.

Bipolar disorder and drug addiction are both mental illnesses that can be caused by a complex mix of factors. It's possible that the same factors are contributing to both conditions in people who experience them at the same time. For example, the National Institute on Drug Abuse explains that certain genetic differences may contribute to both bipolar disorder and addiction.

2. Symptoms of bipolar disorder may contribute to drug use and addiction.

Nadia Bening, MD, a psychiatrist at Driftwood Recovery Center in Austin, Texas, tells WebMD Connect to Care that a large number of people with bipolar disorder may try to self-medicate with drugs or alcohol to deal with their symptoms. According to Bening, people may use different drugs during manic or depressive episodes for different reasons. 

During a manic episode, someone may use amphetamines or cocaine to prolong the period of high energy and excitement, or they may use downers like alcohol or sedatives to try to calm down. While experiencing a depressive episode, they may use stimulants in an attempt to elevate their mood or energy level, or sedatives to distract from feelings of sadness or hopelessness.

3. Drug use and addiction may contribute to the development of bipolar disorder. 

“Although people with bipolar disorder may turn to drugs or alcohol out of a need to stabilize their moods,” Bening says, “engaging in substance abuse has the opposite effect, making the symptoms of bipolar disorder worse.” Substance abuse can make manic or depressive episodes last longer, or make their symptoms more severe. Bening explains that substance abuse can also lead to changes in the brain that may contribute to the development of bipolar disorder.

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